Meet Mark

Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

Do Statins Reduce Small, Dense LDL? Fasting Sure Does

I came across an interesting statin study the other day. It’s from last year, but I hadn’t seen it until recently. The study, entitled “Statins Do Not Decrease Small, Dense Low Density-Lipoprotein,” sought to understand the effect of statin therapy on small, dense LDL, the truly “bad” kind of “bad” cholesterol, the stuff that’s strongly associated with increased heart disease risk in many studies. We know that statins reduce LDL cholesterol – they are extremely effective at curtailing the cholesterol-synthesizing hydroxy-methyl-glutaryl-coenzyme A reductase, if you’re into that sort of thing – but their effectiveness at lowering sdLDL is unknown. They reduce the rate at which cholesterol is produced and that’s as specific as it gets.

Researchers at the Cardiovascular Center of Korea University’s Guro Hospital assembled a group of 612 heart patients, some with confirmed coronary artery disease (CAD) but most without. They were divided into two groups on the basis of statin use; subjects who had been taking statins were put in one group, while subjects with no prior statin use formed the control group. Both groups were again divided based on CAD. In the statin-treated group, 119 had CAD and 53 didn’t. In the control group, 130 had CAD and 310 didn’t.

Overall, statin users saw drops in absolute LDL and sdLDL numbers (as expected), but the proportion of sdLDL to large fluffy LDL increased when taking statins. This effect was particularly pronounced in non-CAD patients. Among CAD patients, statins had a smaller effect on the sdLDL:large LDL ratio, but it was still present. Statins had the definite effect of increasing the proportion of sdLDL, regardless of CAD status.

How much does this even matter? Is it proportion of sdLDL or absolute count of sdLDL that we should concern ourselves with – or neither? I know where I lean.

Besides, if it’s reducing sdLDL you’re interested in, you might just consider intermittent fasting. In a new study just released, researchers put obese adults on an alternate day fasting protocol for eight weeks and monitored their blood lipids. The results were pretty dramatic. You got all the usual improvements that go with fasting – reduced LDL and triglycerides, weight loss, lowered waist circumference – plus a big drop in small, dense LDL. To my knowledge, fasting has never been shown to explicitly lower sdLDL. It’s not that surprising, sure, but it’s certainly nice to see it confirmed. Best of all, subjects saw the biggest improvements in the third phase of the study, when they graduated from alternate day fasting with controlled feeding to alternate day fasting with free feeding.

Speaking of fasting, a few people wondered aloud in last week’s comment section for my sample week post about why I choose to fast after working out instead of immediately feed my starving muscles crying out for sustenance. I gave a quick account why (at this stage in my life, I’m not too worried about putting on muscle or refilling glycogen right away, and I prefer the fat burning, growth hormone promoting effects of post-workout fasting) but I came across a study that kind of addresses this. While the post-workout “protein synthesis” window is a real thing, it’s not fleeting. No matter what the biceps specialists down at the gym tell you, your muscles won’t atrophy just because they don’t receive an immediate protein infusion; according to the results of this study, you actually have about twenty four hours of heightened muscle sensitivity after working out. So, don’t stress out about getting in that food right away post-workout. If you feel best doing it, by all means: eat. In fact, if you’re looking to bulk up, go ahead and eat a big meal after your workout. Just don’t worry about wasting away if you don’t. Cause you won’t.

One more thing before I go: Oprah and her team of staffers are currently on a vegan challenge. Or maybe they just wrapped it up; I’m not sure. I didn’t – and still don’t – plan on saying much about the whole fiasco, since the woman could erase me from the face of this planet with a single phone call, but I enjoyed reading that one of the biggest beneficial outcomes attributed to the new diet was that the staff was going through a record amount of toilet paper. Isn’t that a lovely bit of data on a Monday morning? I thought so too.

Great post, and it supports what I have been doing as of late last year. I read too that there is no specific need to eat soon after a workout. I workout fasted, and now I wait sometimes 5-6 hours before I eat after a workout. I feel great, and I am still getting stronger.

I have a nutrient dense drink (protein, super food, leucine, dextrose) while I work out, but that is because I want the hypertrophy that it (via insulin) promotes. But, like you I wait about 5 hours after lifting (I train at “lunch time”) and eat my 1st meal about 6. It works great for my goals.

Thanks Mark, for another great post on statins. They just keep looking worse the more I read about them.

Despite being 5′ 9″ and 140 lbs and a regular exerciser and vegetable nut, I was prescribed that poison for about a year–my GP even had me seeing a cardiologist–simply because my total cholesterol was 300 (HDLs and triglicerides are normal.)

The cardiologist had me doing treadmill stress tests (twice–the first time he said they were “the best results” he’d ever seen–duh!–and still had me do it again a year later with, *surprise,* the same results–talk about insurance fraud!) and then was dismissive regarding my concerns about my liver enzymes being elevated to 3X normal levels. Explained that this was just an “unfortunate side effect–it’s the best treatment we have available right now. You’re just going to totally have to stay away from alcohol” (I explained I drank a glass of red wine every other day with dinner) “so we can save every last one of your liver cells for these drugs” (not making this up–those were his exact words.)

I would have been better off with the wine.

Quit the statins a few weeks after that and never looked back. I just hope I stopped before any serious damage was done. Decided I had to take charge of my own health as, evidently, most doctors cannot be trusted to do so. I understand that most doctors are trying to patch holes in the health of people that want a quick fix to the problems they have largely created for themselves with their poor lifestyles. But I was not one of those people–I mad it clear I sought alternatives and was willing to do the work necessary to avoid drugs. I was more or less scoffed at.

Not surprisingly, I discovered recently that the cardiologist who was willing to sacrifice my liver to pay Paul received multiple payments for “speaking engagements” in 2008 and 2009 on behalf
of all three of the makers of statin drugs (one of these payments was almost $10,000–for one engagement).

Thanks Mark–without the information you and lipid skeptics provide, I and many other’s like me would be left in the dark.

OMG PLease sue him for malpractice. I had a doctor explain zoloft side effects to me once when my mom asked about risks/ suicide… “well what happens is that when you are depressed you are really really tired, Zoloft gives you the energy in the short term to finally pick up the gun and pull the trigger before the drug has time to fully work”

In a just world, I could sue for malpractice. In the real world, where statins are the protocol treatment for total cholesterol in the 300s and a gastroenterologist that doesn’t want to step on professional toes gives the medical opinion that liver enzymes up to 4X normal are OK if “monitored regularly,” my medical chart at this cardiologist’s office has a SOAP note with the statement “patient non-compliant with recommended treatment” in the assessment section. No lawyer would touch that even if I wanted to sue.

I don’t have liver failure (that I know of–last I checked, my liver enzymes were normal) so I’m content.

Sorry to hear about your mother’s experience with that doctor. Working with doctors all day long, I can tell you some of them are capable of saying some of the most obtuse, innane and antisocial things I’ve heard come out of anyone’s mouth.

You could sue, but you would lose. Most doctors are only trying to do what the guidelines dictate. Let’s say a patient had a total cholesterol of 300, and the physician did not take “appropriate” measures: lifestyle modification -> lipids still abnormal -> medical therapy……and then the patient had a heart attack. That doctor would certainly be found guilty of malpractice.

In my city, most people are unwilling to take any step towards “owning” their health. That’s why the demand for medications is so high…not because doctors do speaking gigs. By the way, doctors giving sponsored talks are only allowed to present FDA approved indications for the drug (by law).

I am a physician, and I fully respect any patient that is willing to take control of their health.

Great post, Mark! I have a few questions about the protein synthesis part.

The fact that muscles are sensitive to myofibrillar protein synthesis up to 24 hours later is new and wonderful news to me. I wonder if that sensitivity is diminished compared to immediately following resistance training, though.

If I read the article correctly, there was a resting group (no workout) and a group who consumed protein 24h after resistance training. The second group was still more sensitive to protein synthesis.

However, I would like to see a 3rd group, who ate protein 30-60 minutes after resistance training to see how their level of sensitivity compares to the 24h group.

Is it the same? Is it highest right after working out, and slowly diminishes over a 24h period until it returns to the resting level? Could one get more myofibrillar protein synthesis by eating right away as opposed to 24h later?

I’ve had people mention that quote from Oprah too… She should perhaps go back to statistics class, a correlation does not mean a cause, and this was not studied with other variables (consumption of grains, consumption of unhealthy oils, etc) included.
The proof is definitely in the pudding (and it is rather easy to see who has been eating said pudding)

Pleased to hear the window for protien uptake is bigger than what you might hear at the gym. I’m often not very hungry after a long bicycle or hard gym workout. Thirsty, though. Love our old Soda Stream.

Dear Mark, I dont want to bother you per email, but maybe you will read this post: If you have some good research, I would find it WONDERFUL if you could make a post on women’s diseases and Primal Eating: women these days seem to be plagued by PCOS and HAIR LOSS. It is like our women’s “cholesterol” epidemics… Thanks so much! I only trust your advice these days 🙂

don’t any of them get it that the reason they are feeling better eating vegan isn’t because they cut out meat and animal fat…it’s because they cut out processed junk food? Why can’t any of them see that? Why do I have to keep hearing from vegans that “we were never meant to eat meat”??

I would say (as a woman myself) it has more to do with the combination of women being (a) worried about being fat, and (b) worried about how others perceive them, and quite a bit of (a) and (b) combined.

Lierre Keith has a more in-depth, thoughtful discussion of the “whys” in The Vegetarian Myth. If you haven’t read it, give it a try – it’s quite something.

Brian, I am female and I agree with you even though I know some females who love meat. Mostly I notice it is males who lust after meat. Women, in the main, not so much. Exactly why this is, I am not sure. I do find it curious.

I was a vegetarian for 30 yrs or so and briefly a vegan. Before discovering Vegetarianism, I used to hate the meat isle when grocery shopping. Totally grossed me out. When I discovered vegetarianism I was over joyed. I don’t have to eat meat?…Yea!

I am still the cook and still raw meat grosses me out even after being Primal for several years. I try not to think about it. When I see a cow in a field, I can’t imagine why anyone would think it looks good to eat.

Luckily we have access to buying meat from a farm that takes good care with their animals since I have a hard time with the way factory farms are run.

I read a study somewhere that one hypothesis this could be is due to the fact that men crave meat and animals more and can digest it better in general is the fact that animal protein is rich in testosterone. Women’s bodies on the other hand, don’t crave it as much as their bodies’ equilibria don’t shift to far in the testosterone hormonal scale.

Not saying they don’t need testosterone because both genders don’t get enough of it in modern diets, but it is interesting that it’s all just because of your body’s equilibrium and hormones.

That *may* have something to do with it as their is some evidence that small differences between enjoyment of violence (both to same and other species) and capacity for empathy do exist, in a very general way, between the sexes. But considering how most farm women handled the butchering before the industrial revolution, I think most promotion of vegan diets arise simply through ignorance of agriculture. Very few people have any contact with their food or the processes that produce it until its sitting on the supermarket shelf. Its easy for someone to learn just enough about agriculture to think they know, but yet still be ignorant. To someone who has never had contact with the process, it’s very natural to take a black-and-white stance and assume that anything involved with animals, especialy killing them, must be terrifying and painful while anything promoting the protection of animals is inheriently good. Of course, differences between wild vs domestic quality of life and merciful nature of death never come into play because all one can imagine are cute, furry little animals frolicking in the “wonderful” wild. Considering that almost no one actually has to participate in the killing/butcher aspect today, it’s probley more of a culturally-ingrained response that all killing is evil and wrong rather than a reluctance to actually participate in it: a culturally-ingrain response that is definately more directed towards the idealized image of “soft” “nuturing” women more than “tough” “macho” men.

If anyone does object the eating meat because of the killing aspect, they really should spend a season in a combine or swather, especially in the winter wheat feilds. The death of livestock in the slaughter house is an instantanious, wonderful, blessed death compared to the death of a deer fawn that gets “processed” through the cutting head (fawns love to hide in grain crops and being the same color as the crops while also refusing to run away, you never even know they are there until they’re already in the sickles). But as horrifying as the first is, it’s when, no matter how hard you try, you literally shred-to-peices your 100th in one season that you really begin to question the “bloodless,” “merciful” nature of a vegan-based argricultural system.

Wow, Methamorphose. That is the most graphic explanation I have read about harvesting grains. Horrifying.

I think you are on to something about the violence-empathy thing. I’m sure our natural instincts come into play.

Being as humans are very adaptable and we can pretty much get used to anything, explains to me to some extent why women are willing to be the butchers on farms or in some cultures. It is a matter of necessity if the family is to eat.

In modern America, we don’t have to be the butchers. It makes it easier for the empathy part of ourselves to dominate I suppose. Then the ignorance of farming practices takes over.

Honestly though, I can’t say it was originally the empathy part of myself that was the reason the raw meat grossed me out. It just looked so unappetizing. Still does.

No offense taken here, Brian, I’m pretty short on tolerance for feminists myself most of the time. But I will say that I, who was raised on a farm and taught to hunt, fish, and slaughter animals raised for food, am much less squeamish than my upper-middle-class urban husband. (He won’t let me buy whole fish, with heads on, at the market because they’re “looking” at him!) He also refuses to reach into a poultry carcass to remove the packet of giblets — I have to do it for him. Lol.

Your comment generated lots of interesting replies. As many said (or alluded), social roles and expectations probably play a role. More than once I have ordered beef while my husband got a salad and a server who had not taken the order switched our meals. I’m female, trim and not shy at all to point out that I like meat…buying it, hunting it, cooking it, eating it. But I’m not typical. I agree, women are more likely to avoid meat. It’s just how the genders are conditioned socially I think. I’m recalling a study about how people would eat less if seated by an overweight person who was pigging out, but they’d eat more if seated by a trim person who was pigging out. This must have something to do with people being concerned about how they might be judged or perceived by others for what they eat. Peer pressure. I’m sure readers out there who have had weight problems have felt embarassed to eat food that’s perceived as fattening, in front of others. Probably they suffer sneers and maybe even rude comments. It’s easier to flaunt eating that steak if one is trim. And in general, females are more self-conscious about their weight and physical self-image. So I think this self-concept factor may play a role in gender-related diet differences. Guys who are wolfing down steak might be thinking, “They will see what a macho carnivore I am,” while women might be thinking, “They will see what a light, health-conscious eater I am” when they eat salad. Or maybe this is way off base, I don’t really know. Men do celebrate eating meat more. I just don’t hear my female rock climber friends say, “I can hardly wait to chow that huge tri tip back at camp…” Is there really less inherent desire among females for meat? I don’t think there would or should be. Especially after climbing all day.

Perhaps it has more to do with self inage and a misplaced effort to stay thin. Being surrounded by CW telling you that this is a viable good option to thinness, youth and good health alot of women swallow that cool aid. Then when things go wrong CW says its old age. But, don’t dispair men are getting on the vegan wagon too.

And processed junk poly oils too. But it’s all in keeping with their longstanding tradition of perverting the true facts & attributing the benefits to their political ideals.
We will continue to hear these inanities because their brains are defective from avoiding saturated fats & cholesterols in their diets since they’ve demonized those also.

Got a question. I’m not clinging to the lipid/cholesterol hypothesis, but…I understand that dietary cholesterol that is NOT oxidized is not a problem, but what is your take on dietary cholesterol that IS oxidized. I am reading all of this stuff about oxLDL and not sure what to make of it. I eat a LOT of cooked eggs with beaten yolks and am curious what you think of this. Any concerns?

From Mercola: “Eat eggs in their healthiest form, which is raw. The next best would be soft-boiled, and then sunny-side up with the yolk still very runny. Raw eggs are better because cooking them will damage the valuable nutrients like lutein and zeaxanthin, bioflavanoids present in egg yolk that are incredibly important for your vision. Heating the egg protein also changes its chemical shape, and the distortion can easily lead to allergies.

Further, when an egg is overcooked, such as when it is scrambled, the cholesterol in it becomes oxidized, or rancid, and oxidized cholesterol can increase your levels of inflammation and lead to numerous health problems. Additionally the fats in the egg serve as a nearly perfect matrix to help you absorb any fat-soluble supplements you might be taking like krill, vitamin E or astaxanthin.” http://goo.gl/8BqjN

Glad to hear about the post workout fasting. That meme about needing protien w/in 30 minutes of working out or you’ve missed the benefit of your entire workout always annoyed me, even when I kind of bought into it. I never feel hungry right after a hard workout. I would have to force food down.

Gotta get off my father who’s suffering heart disease of those statins! You all should check out Dr. Kurt Harris, MD’s post on his blog PaNu regarding other adverse effects of Statins – it’s pretty technical, but if you want to know the nuts and bolts from an MD’s perspective, you should check it out!

Interesting discussion for me, a type 1 struggling with weight loss. I’ve recently added intense exercise, not just walking. My TDD immediatly dropped 25%, basals already down 25% from HFLC. And I’ve lost 6lb in 2 weeks. It seems to me that glycogen management might be key here. If you renew your stores, it seems you’ll be upping your basal output too, so yah, this whole benefit of exercise may be largely due to glycogen depletion hence insulin reduction. No eaty after worky for me.

Consuming large amounts of protein powder, energy drink, jelly beans or whatever the Muscle Rag can hawk fits in perfectly with CW greed. “Feed those ravaged muscles now before they shrivel away – don’t carry your 3 pounds of chicken breast to the gym – buy our packaged processed protein bomb!!!! Look what it did for him. Get yours today.” Maybe Oprah and her crew can replace the TP with some of those $7.95 an issue slicked up steroid freak ad packages.

Be careful ya’ll Ms O. is gonna get ya!!! Before you know it she’ll put in an apperance here and force feed us all of what ever she is on and you won’t like it.

Hey, but I feel sorry for her really. All these years and she still can’t manage to lose the weight and keep it off.

She might stumble across this site one day after trying everything else in the world. If, she could give it a try perhaps she wouldn’t be hungry all the time anymore. But what would her CW doctors say!!!

I saw the Oprah vegan episode and was horrified. They had Michael Pollan there who was the voice of reason about eating meat although was being drowned out by some tall model-type blonde who managed to write a best seller on the vegan lifestyle (oh and her husband just happens to be one of Oprah’s producers on her new network).

There was a segment where they went shopping at Whole Foods. They put one processed food in the cart after another – fake whipped cream, fake chicken, etc. All in the name of being “kind” to animals and the environment. Are you kidding me??? Not one vegetable ended up in the carriage.

I’m a fan of Oprah but was so disappointed that I wrote a review on her website. The good news is that there were more than a few submissions by reasonable thinking folks — and I think I saw a reference or two to this site!

It’s so sad, really and a perfect example of how messed up we are in this country about food.

On Oprah-
Most SAD followers would be healthier following a HEALTHY vegan diet, for a week it might be a great thing. What this woman is promoting is processed crap, tons of non-fermented soy, not a thing in it’s natural state. Just as unhealthy as SAD.

They need one of the crazy raw vegans to go give them a challenge. Most of them on the cutting edge are low-carb (12 bananas a day is so 2007), no grain, eating some fruit but mainly vegetables & vegetable juice.

As a former raw vegan turned primal/paleo, I don’t think it’s a great way to live but once in a while it will make you feel awesome.

Also- MARK- I keep getting emails from some of those folks that mention you might be debating Gabriel Cousins on diet? I am SO listening in if that’s real!

My girlfriend is pretty enthusiastic about her carnivore ways, especially in regards to red meat. She also used to amateur box, is somewhat of a gun enthusiast, and makes more than me in the business world. Maybe there really is just more social programming in the male/female meat preference, rather than biological factors.

It’s worth noting that she also has a pretty easy time gaining muscle when working out, and has always been very athletic. Could be some benefits to it, for sure.

I really want to try working out and then afterwards fasting. I know it is dangerous but many people had tried that. I am not a fan of fasting but I am really curious about this workout a lot without refueling your body with food.

Guys I have inherited high blood cholesetrol. Dieting, untreated and fasting TSC 440 mg/dl (11 mmol/l in our language). I’m 63 years. No one for four generations back of my family lived past 47 years, all heart attacks. I’ve bneen on statins since they were a number in a trial. TSC around 220, HDL ranging between 60 and 100. CIMT 0.52 mm, not bad eh? No evidence of plaque. Thanks Statins, without you my future was clear. PS my diet’s pretty bad but very little saturated fat.